TUMORS OF THE

GUSTI ANGRI ANGALAN EYE

I11112004
Tumor could be benign or malignant. Benign
tumors grow with clear margin and doesnt
invade other tissue, benign tumors usually
will not metastasize. Malignant tumor
happens when cells divide uncontrollably and
invade other tissues.
TUMORS OF THE
EYELIDS
EPIDERMIS
Stratum corneum
Stratum granulosum
Stratum spinosum
Stratum basale

DERMIS
Connective tissue and
contains blood
vessels,
Lymphatics
Nerve
 BENIGN EPIDERMAL TUMORS
SQUAMOUS CELL PAPILLOMA
Squamous cell papilloma is a very common benign
epithelial tumour with a variable clinical
appearance
Narrowbased (pedunculated or skin tag), pink
broad-based, whitish thread-like (filiform)
hyperkeratotic lesions similar to a cutaneous horn.
The incidence increases with age; at least some
cases result from human papilloma virus infection.
Treatment usually involves simple excision, but
other options include cryotherapy and laser or
chemical ablation.
 Squamous cell papilloma. (A) Pedunculated skin
tag;
(B) sessile lesion; (C) hyperkeratotic filiform lesion
Histopathology in all clinical types is similar,
showing finger-like projections of
fibrovascular connective tissue covered by
irregular acanthotic and hyperkeratotic
squamous epithelium .
 MELANOCYTIC NAEVI
Melanocytic nevi are benign neoplasms or hamartomas
composed of melanocytes, the pigment-producing cells
that constitutively colonize the epidermis.
Melanocytic nevi represent proliferations of
melanocytes that are in contact with each other,
forming small collections of cells known as nests.
The clinical appearance and potential for malignant transformation
of naevi are determined by their histological location within the skin.
Junctional naevus occurs in young individuals as a uniformly
brown macule or plaque. The naevus cells are located at the
junction of the epidermis and dermis and have a low potential for
malignant transformation.
Compound naevus occurs in middle. The shade of pigment varies
from light tan to dark brown but tends to be relatively uniform
throughout the naevus cells extend from the epidermis into the
dermis.
Intradermal naevus, the most common, typically occurs in older
patients. It is a papillomatous lesion, with little or no pigmentation.
Histologically, naevus cells are confined to the dermis and have
essentially no malignant potential

Treatment is indicated for cosmesis or for concern about malignancy

(A) Junctional naevus; (B)
histopathology shows
heavily pigmented
naevus cells at the
epidermal / dermal
junction; (C) compound
naevus; (D)
histopathology shows
naevus cells both at the
epidermal/dermal
junction and within the
dermis; (E) intradermal
naevus; (F)
histopathology shows
naevus cells within the
dermis separated from
the epidermis by a clear
 XANTHELASMA
Derived from the Greek xanthos(yellow)
andelasma(beaten metal plate).
Xanthelasma are yellowish plaques, soft, with clear
margin that occur most commonly near the inner
canthus of the eyelid, frequently bilateral.
Typically affecting middle-aged and elderly
individuals.
They may occur in patients with hyperlipidemia in
about one-third of patients.
Represents collections of lipid-containing histiocytes
in the dermis of the lid.
Fat in xanthelasmata is mainly intracellular, with
lipid-laden histiocytes (foam cells) in the dermis.
Aside from the cosmetic flaw, the patients
are asymptomatic.
Recurrence rate is high in patients with with
persistently elevated cholesterol levels.

Treatment :
1. For small linear lesions, excision is
recommended, as scarring should blend in
with the surrounding eyelid tissue
2. Carbon dioxide and argon laser abration.
 CAPILLARY HEMANGIOMA
Capillary haemangioma (strawberry naevus) is one
of the most common tumours of infancy.
The female to male ratio is 3:1
Facial lesions most commonly occur in the eyelids
It presents shortly after birth as a unilateral, raised
bright red lesion, which blanches on pressure and
may swell on crying.
A deeper lesion appears purplish
 Histopathology shows proliferation of
varying-sized vascular channels in the dermis
and subcutaneous tissue
Treatment to accelerate regression of
the hemangioma :
Intralesional steroid injections
Radiation therapy
 MALIGNANT TUMORS
BASAL CELL CARCINOMA
Basal cell carcinoma (BCC) is the most common skin
cancer in humans.
The most common malignant eyelid tumour,
accounting for 90% of all cases, typically affects
older age groups.
Slowly growing and locally invasive but non-
metastasizing.
Risk factors : chronic exposure to sunlight,
carcinogenic substance.
The tumour arises from the cells that
form the basal layer of the epidermis,
growing locally and destroys tissue.
Surgical therapy is the treatment of choice.
Tumor that limited in the eyelid will have a
reconstruction.
Radiation therapy can be used in patients
with advanced and extended lesions,
radiation therapy is used to shrink the size of
tumor to a smaller size before reconstruction
and not make any disturbance of eyelid
function.
 SQUAMOUS CELL CARCINOMA

SCC is a much less common, but typically more

aggressive than BCC
It can metastasize into the regional lymph nodes.
It occurs most commonly in elderly individuals with
a fair complexion and a history of chronic sun
exposure.
The tumour arises from the squamous cell
layer of the epidermis.
It is composed of variable-sized groups of
atypical epithelial cells with prominent nuclei
and eosinophilic cytoplasm within the dermis

Histopathology shows
acanthotic squamous
epithelium and eosinophilic
(pink)
islands of dysplastic squamous
epithelium within the dermis
Nodular SCC is
characterized by a
hyperkeratotic nodule which
may develop crusting
erosions
Ulcerating SCC has a
red base and sharply
defined, indurated and
everted borders but
pearly margins and
telangiectasia are not
usually present
Treatment :
Treatment of choice of squamous cell
carcinoma is complete surgical
removal.
TUMORS OF THE
CONJUNGTIVA
 CONJUNGTIVAL NAEVUS
A conjunctival naevus is the most common
melanocytic conjunctival tumour; the overall
risk of malignant transformation is less than
1%.
The lesion is typically initially noticed in the
first or second decade.
Compound naevi are characterized by the
presence of naevus cells at the epithelial
subepithelial junction and within the
subepithelial stroma.
Junctional naevi consist of nests of naevus
cells at the epithelialsubepithelial junction
They are uncommon.
Intradermal lesions are confined
subepithelially.
 CONJUNGTIVAL CYSTS
Conjunctival cysts are harmless and benign.
They usually take the form of small clear fluid-filled
inclusions of conjunctival epithelium whose goblet
cells secrete into the cyst and not on to the surface.
Cysts can lead to a foreign-body sensation and are
removed surgically
 CONJUNGTIVAL PAPILLOMA
Conjunctival papilloma are strongly associated with
human papillomavirus infection, especially types 6
and 11.
Lesions are sessile sessile (wide base and flattish
profile) or pedunculated (frond-like)
They are usually solitary but may be multiple.
Large lesions are treated by excision, sometimes
with cryotherapy to the base and the surrounding
area.
 Sessile Pedunculated
papilloma papilloma
Histopathologically they consist of a
fibrovascular core covered by an irregular
proliferation of non-keratinized stratified
squamous epithelium containing goblet cells.
TUMORS OF THE
RETINA
 RETINOBLASTOMA
A retinoblastoma is a malignant tumor of
early childhood that develops from
immature retinal cells.
Retinoblastoma occurring in approximately
one of 20.000 births. In 30% of all cases, it
is bilateral
Retinoblastoma is caused by RB1 gene
mutations, which located at chromosome
13q14 and protein code pRB that helps
supress tumor formation. pRB is a
nukleoprotein which located at DNA and
control the cell cycle at transition phase in
G1 to S.
Clinical Manifestation :
Leukokoria
Strabismus
Hipopion
Hifema
Decreased visual acuity
A grayish white, vascularized retinal tumor will be
observed on ophthalmoscopy.
In its advanced stages, this tumor was formerly
referred to as an amaurotic cat's eye.
Retinoblastomas may exhibit outward (exophytic)
or inward (endophytic) growth or a combination of
both.
Radiographs or CT images that show calcifications
can therefore help to confirm the diagnosis in
uncertain cases.
Fundus appearance of an Endophytic retinoblastoma with
endophytic retinoblastoma tumor cells seeding the vitreous.
Treatment :
Brachytherapy using a radioactive plaque can be
utilized for an anterior tumour if there is no
vitreous seeding, and in other circumstances such
as resistance to chemotherapy.
Chemotherapy. Systemic chemotherapy will
reduce the tumor size, then could use focal
combination, such as laser therapy. Nowadays,
there are a lot combination of regimen, such
Carboplatin, Vincristine, Etoposide dan
Cyclosporine.
Cryotherapy using a triple freezethaw
technique is useful for pre-equatorial
tumours without either deep invasion or
vitreous seeding.
Enucleation is generally indicated if there is
neovascular glaucoma, anterior chamber
infiltration, optic nerve invasion or if a
tumour occupies more than half the vitreous
volume.
THANK YOU